A Meeting of THE MINDS

On a bright, cool June Saturday morning, thousands of people converged on 747 Howard Street in San Francisco, their presence signaled by the ubiquitous blackand-purple tote bags, descending by foot from the hills or hopping off the city’s famous cable cars or scurrying from myriad corner coffee shops and breakfast bistros. Practitioners, basic scientists, researchers, fellows, students, and media all gathered for an innovative educational program covering endocrinology from bench to bedside. For four days, San Francisco’s Moscone Center hosted Th e Endocrine Society’s 95th Annual Meeting & Expo where a record-setting 9,300 attendees met to discuss the latest developments and advances, blockbusters, and bombshells in the world of endocrinology.

Outgoing Endocrine Society president William F. Young, Jr., MD, took the stage the morning of Saturday, June 15, before the first plenary lectures, and expressed his farewells, saying that it had been an “honor and career highlight” to serve as president. He proudly mentioned all of the wonderful things Th e Endocrine Society and its members had accomplished in the past year, and said a special thank you to Scott Hunt, who is retiring as CEO of Th e Endocrine Society after leading the association for 25 years and growing it by leaps and bounds.

The ENDO 2013 participants attended more than 350 presentations detailing everything from obesity, diabetes, endocrine disruptors, thyroid cancer, sex hormones, and more. Hundreds of people filled each room of the Moscone Center, the massive event halls and the intimate theaters, even the stairwells and hallways and tucked-away corners, to discuss the groundbreaking hot topics in their field.

New programs on the schedule for 2013 included feature poster presentations, which provided trainees with a kind of “lightning round” to showcase the information on their posters before inviting ENDO attendees to come by the Expo Hall to see them, as well as the “sandwich symposia,” which allowed for junior presenters to be “sandwiched” among the more senior speakers.

Obesity Takes Center Stage

Taking center stage this year was the growing international epidemic of obesity, which now accounts for 20% of medical expenditures worldwide, but the presenters and their research off ered some avenues to solutions.

Th e overeating of high-fat diets that many people consume are obviously one of the main causes of more and more people growing overweight and becoming obese, but the causes for overeating itself are not exactly always clear. It turns out there could be a number of reasons, whether people are depressed or stressed and are taking necessary medications to combat those emotions, or even something much more troublesome—food addiction.

“Addiction is amplified motivation,” said Gina Leinninger, PhD, assistant professor of physiology at Michigan State University, adding that palatable food especially can amplify the motivation to eat. Ralph DiLeone, associate professor of psychiatry and neurobiology at the Yale School of Medicine, agreed, showing that stimulation of dopamine receptors in mice led to increased food intake, in both fooddeprived and food-replete states.

Felicia Nowak, MD, PhD, an associate professor of molecular endocrinology at Ohio University, and her team showed that male mice whose fathers consumed high-fat diets before conception exhibited increased body weight, providing evidence that “paternal obesity is a predictor of childhood excess weight.” However, she said, these changes tend to be epigenetic—heritable alterations in gene expression— because the off spring weren’t able to observe their father’s eating habits and didn’t even have access to the same high-fat diets. Nowak went on to say that obesity in both parents “more than doubles” the chances that children will be born overweight.

One glimmer of hope, Nowak noted, was that the off – spring of fathers who had high-fat diets ran more on their wheels, suggesting they were “programmed to avoid having fat in them.”

Obesity means a major risk factor for a large swath of endocrine disorders, especially diabetes. The disease costs diagnosed patients $245 billion in the U.S. alone, but developing healthy eating habits—especially at a young age— has repeatedly shown to slow or even stop the progression of this lifelong and costly illness.

Breakfast skipping, for example, tends to be associated with a higher body mass index (BMI). And for women who skip breakfast, according to Elizabeth Thomas, an endocrinology fellow at the University of Colorado School of Medicine in Aurora, that could, in turn, lead to insulin resistance.

“Insulin resistance over time leads to other metabolic disorders,” Thomas said, “including type 2 diabetes.” The study she presented showed that acute insulin resistance developed after just one day of skipping breakfast. But it’s not just poor diet that can lead to problems; so can a lack of sleep. The so-called “24/7 lifestyle” that many patients experience can make patients more susceptible to insulin resistance, the disorder that can cause type 2 diabetes, according to Peter Liu, MD, PhD, of Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center in Torrance, Calif. “We don’t think we need sleep,” Liu said, but longer sleep actually improves sensitivity, even if it’s “catch-up sleep” on the weekends.

Perhaps one of the more complicated ways (compared to diet and sleep) to help patients with diabetes was presented by Steven E. Kahn, MB, ChB, of the Veterans Administration Puget Sound Health Care System and the University of Washington, during the Clinical Investigator Award Lecture. His data suggested that beta-cell dysfunction was the key to the development of type 2 diabetes, as well as a new direction for clinical intervention, so long as swift and decisive action was taken. “If we can act aggressively early on,” Kahn said, “we can preserve betacell function and slow the progression of diabetes.”

Genetics & Early Intervention

Of course, intervening at an early age is a good idea for any sort of possible disease, and again, new studies presented at ENDO 2013 showed promise for helping adolescents and teens in myriad ways. Obese children and teens were shown to be more likely to develop chronic and persistent asthma and allergies when they have a vitamin D deficiency. And the problem is that vitamin D deficiency is common in obese individuals.

Even the fear of obesity is a significant factor in manifesting problems in young people. Anorexia nervosa, a severe eating disorder that especially affects teenage girls, is characterized by an extreme and distorted concern for body shape and image. However, it appears that there could be an endocrinological solution. Th e results of a new clinical trial showed that estrogen replacement therapy decreased anxiety in girls who suffer from anorexia nervosa.

Other concerns for pediatric populations presented at ENDO 2013 included gene mutations, as well as growth hormone irregularities and deficiencies, which can cause any number of problems, from bone problems to short stature to mental defects.

And these disorders are often interconnected and become more apparent as children grow to adulthood. In fact, hypogonadism turns out to be a major risk factor for osteoporosis in men, an often underappreciated condition. Testosterone administration actually showed increased bone mineral density in men, but the treatment is still controversial, because there are still some doubts about that particular treatment’s efficacy.

Genetics plays a major role in the development of these issues; mutations interfere with hormone production, which regulates organ size, bone age, mental cognition, and even facial appearance.

Floating Harbor Syndrome, a rare genetic disease that causes short stature, delayed bone age, and learning disability, is specifically characterized by facial features and is caused by a mutation of the gene SRCAP. Kym Boycott, an associate professor of medicine at the University of Ottawa, showed that the disease is especially given away by the patient’s non-familial nose, “narrow at the root and wider at the nostrils.”

IMAGe Syndrome, another rare disorder that causes short stature and distinctive facial features, is caused by the gene CDKNIC and inherited in a “genomically imprinted manner,” said Eric Vilain, MD, PhD, an assistant professor of human genetics at UCLA. Th e disease also has more severe symptoms like hypoplasia, scoliosis, and osteoporosis.

New insights into diagnosis and treatment of thyroid cancer were offered as well. Brian Netzel, a researcher at the Mayo Clinic in Rochester, Minn., said that there is a need to reduce the difficulty in detecting and diagnosing the disease, which can be done one way by harmonizing assays.

Several presenters agreed that diagnosing and treating thyroid cancer is not only difficult, but expensive, and some tests unnecessarily expose the patients to radiation. Robert Smallridge, MD, an endocrinologist at the Mayo Clinic in Jacksonville, Fla., and Stephanie Fish, MD, an endocrinologist at Sloan-Kettering Cancer Center in New York City both warned that practitioners should use radioactive iodine cautiously as an empiric dose for diagnosis of thyroid cancer.

When it comes to diagnosing and treating patients with thyroid cancer, especially those with distant metastases, “new and better therapies are needed,” Fish said.

Start clearing your calendar now to be in Chicago from June 21 to 24 for ICE/ENDO 2014, a joint International Congress of Endocrinology and Endocrine Society meeting. For more information, go to www.endocrine.org/meetings/ice-endo-2014/endo-2014#/nav/.

—Bagley is associate editor at Endocrine News.

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